After she delivered her infant son in 2006, Darline Turner relished those early hours in her Austin hospital room, changing diapers and playing with her son's fingers and toes.

Everything was going smoothly until a social worker walked in, carrying a binder on subsidized social services like Medicaid and the state's Women, Infant and Children program. Turner, a black woman who at the time was a physician assistant and doula, married and insured, listened to the social worker explain those services for 10 minutes before asking if all new moms got this information — or just her.

“Her face went purple," Turner said. "Her assumption was I was a single mother who was going to need social services."

Turner points to that incident as just one reason that Texas' Task Force on Maternal Mortality and Morbidity needs to study how race, bias, prejudice and socio-economics affect access and care for pregnant black women. Some of that research would happen under Rep. Shawn Thierry's House Bill 2403, a bill considered by lawmakers on the House Public Health Committee on Tuesday evening.

The social worker "didn’t even read my chart," said Turner, who had a history of pregnancy complications, including two miscarriages and delivering her two children by C-section.

"Those are the things that we have to address," she added. "Because if a person, whether they’re conscious of it or not, has that implicit bias, then that’s coming into their treatment plan.”

While the maternal health of black mothers has been studied nationally for years, researchers and advocates have been baffled by recent reports showing black women in Texas are twice as likely to die after a pregnancy-related hospital stay than any other group of women.

Though black women accounted for only 11 percent of all Texas births in 2012, they made up 29 percent of maternal deaths, according to a July 2016 report from the state’s Task Force on Maternal Mortality and Morbidity. White women accounted for 35 percent of births and 38 percent of maternal deaths. Hispanic women were the lowest-risk group, representing 48 percent of births but only 31 percent of maternal deaths.

The task force, created by the Legislature in 2013, found that between 2011 and 2012, 189 Texas mothers died less than a year after their pregnancy ended — mostly from heart disease, drug overdoses and high blood pressure. And the medical journal Obstetrics and Gynecology reported in August 2016 that Texas’ maternal mortality rates had nearly doubled between 2010 and 2014.

Despite the dire data, getting more legislators to focus on deaths among mothers — particularly black women — has been a challenge for advocates this session

“Who is going to listen to us talk about black women?” That’s the question Marsha Jones, executive director for The Afiya Center, a Dallas-based group that focuses on reproductive health access for black women, said she and her staff asked themselves before the 2017 legislative session began.

Jones said the alarming rate of black mothers dying doesn't “sit as heavily” as it should with non-blacks and that the lack of outcry around black maternal deaths in Texas connects to the larger issue of black women being left out of conversations around reproductive justice.

“If people were more aware of this, the legislators would have to do something, and even our white allies would have to move their gauge a little bit more,” Jones said. “They can’t be concerned about access to abortion while not making sure black women are able to have their babies without dying.”

Under Thierry's bill, the state's Task Force on Maternal Mortality and Morbidity would study health-related factors for black mothers, including heart disease, eclampsia, high blood pressure, obesity and stress. The task force would also look at how socioeconomic status effects black mothers. The task force would be charged with making recommendations by 2018 on patient outreach, health care provider training and best practices other states have used to reduce maternal mortality rates.

"As an African-American woman, I have a four-year-old child, I have great health care and I was maybe living in a vacuum myself before I found this out," said Thierry, D-Houston. "To have the opportunity now to make an impact means a lot to me."

But Lovell A. Jones, professor at Prairie View A&M University and executive director of the national Health Disparities, Education, Awareness, Research and Training Consortium, said the state needs more solutions, not studies. He said researchers need to talk to the black community and reach out to local groups to better understand the social issues affecting maternal public health.

“Addressing health is local,” Jones said. “You may have a national solution, but until you adopt and modify it for the local area, it’s probably not going to work.”

Sen. Borris Miles, D-Houston, said the black women dying during and after childbirth “speak for themselves.” He said after reading the task force’s most recent report, maternal deaths became a priority for him.

Miles pointed to measures he has filed in the Senate, including looking at how the state reports maternal deaths and getting more women automatically enrolled in the Healthy Texas Women Program. That state-run program allows low-income women between 15 and 44 to receive services for pregnancy and STD testing, breast and cervical cancer screenings, contraceptive counseling, postpartum depression screenings and help with chronic diseases like diabetes, high blood pressure and high cholesterol.

“We may know that something exists, but we have to figure out why it exists, and that requires study,” Miles said. “We have to ask, what’s the best way of fixing this proficiently, and as legislators, what can we do to help?”

Read related Tribune coverage:

Texas’ maternal deaths have been sparingly mentioned during the legislative session, overshadowed by issues such as child welfare, the so-called “bathroom bill” and sanctuary cities.

Two recent studies have highlighted the increasing rate of maternal deaths in Texas, but researchers say they can't explain why it's happening.

Disclosure: Prairie View A&M University has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.

Editor's note: This story was updated to reflect that Darline Turner was approached by a social worker who explained subsidized social services.

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